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Presentation on theme: "Session 10: Infant and Young Child Feeding in the Context of HIV"— Presentation transcript:

2 PurposeTo review optimal infant and young child feeding practices to improve counseling skills on infant feeding in the context of HIV

3 Learning ObjectivesDescribe optimal infant and young child feeding practices.Explain infant feeding options for HIV-infected mothers.Know key components of counseling women, their partners, and their families on infant feeding in the context of HIV.

6 PMTCT Entry Points for Infant FeedingPregnancyCounsel on infant feeding options and self-care including nutrition and preparing for the future.Post-natal periodCounsel on and support infant feeding options.Prevent and treat breastfeeding problems.Treat infant thrush and oral lesions.Counsel on complementaryfeeding and breastfeeding cessation.Counsel on preventing re-infection.

8 Informed ChoiceHIV and breastfeeding policy supports breastfeeding for infants of women without HIV infection or of unknown status and the right of a woman infected with HIV who is informed of her serostatus to choose an infant feeding strategy based on full information about the risks and benefits of each alternative.UNAIDS/WHO/UNICEF

9 WHO Recommendations on Infant Feeding for HIV-Positive WomenHIV-negative or of unknown HIV statusExclusive breastfeeding for 6 months and continued breastfeeding for 2 years or beyondHIV-positive womenMost appropriate infant feeding option for HIV- exposed infant depends on individual circumstances, including consideration of health services, counselling and support

10 Determination of AFASSYESNOCounsel mother on exclusive breastfeeding.Will you have a problem with your family or friends if you do NOT breastfeed?Can you get access to clean safe water, keep utensils clean, use a cup and spoon?Are you able to buy enough infant formula or animal milk?Are you able to prepare feeds for the child every 3 hours both day and night?Support replacement feeding with formula or animal milk.

12 Exclusive Breastfeeding PracticesGive the infant only breastmilk.Initiate breastfeeding within 1 hour of birth.Make sure the infant is attached and positioned correctly at the breast.Breastfeed frequently.Continue breastfeeding when the mother or infant is sick.Express breastmilk if not feeding the infant directly.

13 Additional Breastfeeding Practices for HIV-Positive MothersStop breastfeeding from the infected breast and seek treatment.Seek medical care when ill.Check the infant’s mouth for sores and seek treatment if necessary.Transition to replacement feeding when it becomes AFASS.

15 Expressing and Heat-Treating BreastmilkThe breastmilk is heated to 62.5°C for 30 minutes or boiled briefly and cooled immediately.Heat destroys HIV.The milk retains some nutritional benefits but loses anti-infective factors.The milk should be stored in a cool place.The milk should be fed to the infant in a cup, not a bottle.This is time consuming and difficult to maintain.

16 Wet nursing by an HIV-Negative WomanThe wet nurse must be confirmed HIV negative and understand the importance of safe sex.The wet nurse must follow optimal breastfeeding practices.The wet nurse must be able to feed the infant frequently, including at night.

17 Commercial Infant FormulaRequires support from the health system and communityRequires clean water, sterilized utensils, and correct hand washingRequires a steady supply of commercial or home-prepared formula—20 kg over 6 monthsRequires correct mixing

19 Breastfeeding CessationGradually reduce the frequency of breastfeeding.Increase breastfeeding intervals to every 4–6 hours.Gradually cut out one or more night feeds.Teach the infant to drink expressed breastmilk from a cup.Cup feed expressed breastmilk in between breastfeeds.Try not to breastfeed the infant to sleep.

20 Feeding the Non-breastfed Child 6−24 Months OldAgeKcalFeeding frequency6−8 months600/dayMeals: 4−5 times a daySnacks: 1−2 times a day9−11 months700/day12−23 months900/dayMeals: 4−5 times a day Snacks: 1−2 times a day

21 Complementary FeedingFeed the child in a separate bowl.Interact with the child during feeding (responsive feeding).Practice good hygiene and safe food preparation.

22 Feeding the Sick ChildIncrease breastfeeding or replacement AND complementary feeding during and after illnessIncrease fluids (including breastmilk) during and after illness.For diarrhea, give zinc supplementation for 10−14 days according to WHO protocol.For diarrhea, give provide low osmolarity ORS to children over 6 months old.Seek help if illness persists or if the child is unable to eat after several days.

23 ConclusionsHIV-positive women must weigh the benefits and risks of breastfeeding before making infant feeding choices.Alternatives to breastfeeding must be AFASS.Women need good counseling and support to select the best feeding options and follow optimal practices.